Information Disclosure - Health Insurance

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Forums › Finance and wealth management › Information Disclosure - Health Insurance

firefuze

510 posts

Ultimate Geek

#310543 30-Oct-2023 22:46

Interested in getting health insurance and notice they all insist you disclose or will be required to disclose upon claim, your family history of illness, in particular, cancers.

Am I really required to provide such information? My mother has had cancer and the wording implies I likely won’t have cancer cover if I disclose this. Yet I’ll pay the same premium. In my opinion I feel it’s unjustified and discriminatory, why should I be denied cover for something out of my control? Increased risk = increased claim likelihood I guess, just business.

Wording they use is “that you know of”. How are they (insurance) to make that determination? Could just state you’re estranged from family and have no knowledge of their medical history.. Imagine they can’t request someone else’s medical records, so what evidence would they be requesting to determine as such? Just your own word?

Curious to know what the legality is behind such requests for information/disclosure or any similar experiences.

Handle9

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#3153836 31-Oct-2023 00:18

Yes you are required to disclose pre-existing or family conditions that you know about. In some cases it will mean nothing, in some cases it will mean an exclusion in the policy for a period of time or a loading to the premium. In more extreme cases they may decline coverage.

Insurance is a financial product and it comes back to the "reasonable person" test. If it goes to court what would a reasonable person do if they knew about family history. They are insuring your health so they are entitled to know the level of risk they are exposed to and whether they want to insure you.

If you fail to disclose a pre-existing condition or lie about it you are likely to be declined coverage in the event of a claim in the case that your insurer finds out about it. In a more extreme case you could be charged with making a false declaration.

eracode

Smpl Mnmlst
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#3153844 31-Oct-2023 02:32

The principle of ‘utmost good faith’ applies to every type of insurance. It is always a Very Bad Idea to try and game the system. Same goes for dealings with the IRD imo - and it’s simply a great guiding principle for life overall.

Sometimes I just sit and think. Other times I just sit.

eracode

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#3153845 31-Oct-2023 02:55

firefuze:

Wording they use is “that you know of”. How are they (insurance) to make that determination? Could just state you’re estranged from family and have no knowledge of their medical history.. Imagine they can’t request someone else’s medical records, so what evidence would they be requesting to determine as such? Just your own word?

You might be surprised at how easily you could get tripped up. For example, a GP will commonly ask whether there’s any family history of certain types of illness. Let’s say a parent or grandparent had cancer - so you tell the GP. The GP will say “Let’s get you a colonoscopy/breast screening - just to be sure you’re OK”.

That family history will be recorded in your own medical records as the reason why the test was arranged. The insurance company could easily discover that without needing to see other family members’ medical records.

Sometimes I just sit and think. Other times I just sit.

dolsen

1476 posts

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#3153850 31-Oct-2023 06:29

Something an insurance broker got me to write in that area was for the insurer to contact your doctor for the purposes of full disclosure. Not sure if that is still an option, but seemed to cover it off without relying on my memory.

gzt

17104 posts

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#3153858 31-Oct-2023 08:10

I have not heard of this. I'd guess they won't increase your premium or deny your cover unless it's conclusively inherited type and/or high probability you will be affected.

Personally don't know much about these things. I'd call the company on the general enquiry line and ask what the question is about and the likely outcomes for insurance.

If they denied insurance to everyone with cancer in the family they would have no customers. I doubt its particularly strict unless it's inheritable maybe.

MikeAqua

7773 posts

Uber Geek

#3153914 31-Oct-2023 10:01

My mother died of cancer quite youn. That didn't stop me getting life insurance. Not all cancers are hereditary, and some cancers that affect women do not affect men and vice versa.

My approach is to give the potential insurer access to my full medical records. It's then up to them to do their due diligence.

Mike

duckDecoy

896 posts

Ultimate Geek

Subscriber

#3153921 31-Oct-2023 10:19

firefuze:

Interested in getting health insurance and notice they all insist you disclose or will be required to disclose upon claim, your family history of illness, in particular, cancers.

Am I really required to provide such information? My mother has had cancer and the wording implies I likely won’t have cancer cover if I disclose this. Yet I’ll pay the same premium. In my opinion I feel it’s unjustified and discriminatory, why should I be denied cover for something out of my control? Increased risk = increased claim likelihood I guess, just business.

Wording they use is “that you know of”. How are they (insurance) to make that determination? Could just state you’re estranged from family and have no knowledge of their medical history.. Imagine they can’t request someone else’s medical records, so what evidence would they be requesting to determine as such? Just your own word?

Curious to know what the legality is behind such requests for information/disclosure or any similar experiences.

I listed all my familial illnesses, including cancer, and I still got health insurance without those exclusions. And also some insurance policies will simply give you a couple year stand down on certain things, for example you cannot claim for cancer for 2 years but are then covered after that.

Don't under any circumstances lie or omit from your application. If you are found out and they reject your claim and cancel your insurance, you may be obliged to disclose this fact to all your other insurers too (not just health). And not being insurable is a terrible place to be in, for example banks will normally require insurance if you're applying for a mortgage for a house, so if you cannot secure insurance...

When I last applied for a new health policy I listed everything I could remember and then also wrote that in case I have forgotten anything please feel free to contact my doctor to get my records, and told my doctor he could share them. Hopefully that would be reasonable if it turns out I forgot something.

We have recently had to go through the public hospital system for both myself and my son, and I thank the spag monster in the sky that we had insurance and were able to bypass some of the tests we needed rather than wait for our turn (they said it would be a 9 month wait for my son to see the next specialist!). So in our experience getting it is definitely worth it even if its simply to expedite the process.

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frankv

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#3154014 31-Oct-2023 14:52

Handle9:

They are insuring your health so they are entitled to know the level of risk they are exposed to and whether they want to insure you.

I think "entitled" is too strong a word. No-one is entitled to know anything about you or your family.

However, they can put pretty much whatever conditions they like in the contract (excluding race, gender, etc). If you think it's too invasive, propose a variation, or walk away. But I'd suggest that if you say "What about if I don't declare my family history?" They'll either decline or put you into the worst-case family history category.

It would be difficult (and fraudulent) to pretend you didn't know your mother died of cancer. Went to her funeral? Received a bequest? Lived in the same house about that time? Visited often? Phoned, even occasionally? Hearted her posts on Facebook? Discussed it with a relative or friend? Announced it on a public forum i.e. Geekzone?

allan

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#3154112 31-Oct-2023 16:51

frankv:

Handle9:

They are insuring your health so they are entitled to know the level of risk they are exposed to and whether they want to insure you.

I think "entitled" is too strong a word. No-one is entitled to know anything about you or your family.

However, they can put pretty much whatever conditions they like in the contract (excluding race, gender, etc). If you think it's too invasive, propose a variation, or walk away. But I'd suggest that if you say "What about if I don't declare my family history?" They'll either decline or put you into the worst-case family history category.

It would be difficult (and fraudulent) to pretend you didn't know your mother died of cancer. Went to her funeral? Received a bequest? Lived in the same house about that time? Visited often? Phoned, even occasionally? Hearted her posts on Facebook? Discussed it with a relative or friend? Announced it on a public forum i.e. Geekzone?

Of course they are entitled to know. You are asking them to to provide you with insurance for your health. Like all insurance, they are not going to insure something that has an absolute certainty of occurring. On the other hand, based on others experience above regarding family members with cancer, etc I don't think the OP has much to worry about.

I don't have experience of working in health insurance, but back in my day of dealing with car insurance, if a 22 year old with multiple speeding tickets/dangerous driving charges wanted to insure a V8 Mustang, I can assure you we would have regarding that as a risk not worth taking on.

SomeoneSomewhere

1802 posts

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#3154223 31-Oct-2023 21:43

They aren't regulated to offer insurance on equal terms regardless of family or pre-existing history, so... they won't. Be glad you at least have the public system as a backstop.

Insurers don't care whether something is/was under your control or not, only whether it's predictable.

Senecio

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#3154313 1-Nov-2023 08:41

Insurance companies are resourceful buggers when it comes to assessing a claim. You'd be amazed at where they can dredge up information from if it helps them to deny a claim. Always best to be upfront, will save a lot of hassle down the line.

Also, if they do uncover an undisclosed condition then they may deny you cover going forward. This will have to be disclosed to all future insurers.